In order to accomplish serial processing of updates, many dbmss use ____.

Chapter 14: Fundamentals of Electronic Information Systems

Martin J. Smith, MEd, RHIT, CCA

Learning Objectives

Discuss the major components of an information system

Identify principal activities of information systems

Describe the major types of information systems and give an example of each

Distinguish between the purposes and functions of MIS, DSS, ES, and KMS

Differentiate between the various types of computers

Describe the steps in the systems development life cycle

Explain the vendor selection process

Identify the three main types of system software and provide an example of each

Discuss the purpose of an electronic database

Describe the purpose of a database management system (DBMS)

Explain the use and components of a data dictionary (DD)

Summarize the purpose and benefits of a data warehouse

Understand the functions of a communications system’s components

Compare and contrast clients and servers

Describe the general practices used to ensure data and computer security

Compare and contrast local-area networks, wide-area networks, intranets, extranets, and the Internet

Become acquainted with the policies that must be incorporated into the use of an information system

Describe functions associated with the management of computer systems

Identify new and emerging personal productivity software

Key Terms

Application service provider (ASP)

Application software

Artificial intelligence

Assembler

Assembly language

Barcode

Bus topology

Business process

Business-to-business (B2B)

Business-to-customer (B2C)

Chief information officer (CIO)

Client

Cloud computing

Column/field

Communications technology

Dashboard

Data dictionary

Data mining

Data type

Data warehouse

Database

Database management system (DBMS)

Decision support system (DSS)

Direct cutover conversion

E-health

Encoder

Enterprise-wide system

Executive information system (EIS)

Expert system (ES)

Extranet

Foreign key

Graphical user interface (GUI)

Hardware

Health information exchange (HIE)

Information system (IS)

Information technology (IT)

Inputs

Integrity constraints

Internet

Intranet

Key field

Knowledge management system (KMS)

Language translator

Local-area network (LAN)

Machine language

Mainframe

Management information systems (MIS)

Management support information system

Mesh topology

Minicomputer

Natural language

Network

Network protocol

Object

Object-oriented database

Object-relational database

Operating system

Operation support systems

Outputs

Parallel conversion

Peripheral

Phased conversion

Physical topology

Primary key

Productivity software

Programming language

Relational database

Ring topology

Row/record

Screen prototype

Secondary storage

Sequence diagram

Server

Software

Specialty software

Star topology

Strategic information systems planning

Structured query language (SQL)

Supercomputer

System software

Telecommunications

Transaction-processing system (TPS)

Turnkey systems

Unified modeling language (UML)

Use case diagram

Utility program

Wide-area network (WAN)

Wireless network

Workstation

Introduction

The computer is now an essential component for the collection and management of health information. While the planning for the widespread use of electronic health records has covered several decades, recent federal initiatives and legislation has ensured that the use of computers in healthcare delivery is now a requirement for healthcare providers.

Computers comprise a major portion of an organization’s information system (IS). The IS helps healthcare organizations meet the growing demands of patients, providers, and payers for electronic information. Efficient management and distribution of information are indispensable to a healthcare organization’s operation. Because of the principal role that computers play in an organization’s healthcare information system, it is vital that HIT professionals understand what makes up a well-constructed computer IS.

It is also essential that health information technicians (HITs) understand their evolving roles and responsibilities in working in this new e-health environment. To be effective workers, in addition to knowing the basic structure of an electronic information system and how it is applied to the healthcare environment, HITs must also understand the language of IS. This chapter introduces the primary components of an IS and discusses its essential elements, including data, people, processes, and computer systems. The chapter serves as a foundation for chapters 15 and 16 of this text.

Theory into Practice

Every healthcare provider must adopt an electronic health record no matter what setting they practice medicine in. Although the following example refers to the physician office setting, the challenges faced apply to all settings. This case study from the August 2009 edition of the Journal of AHIMA discusses a systematic planning process for successful EHR implementation in physician practices (Gaudreau and Palermo 2009, 80).

One consistent theme emerges from EHR implementations in physician practices: almost everyone underestimates the complexity, time, and effort required.

Implementing ambulatory EHRs includes all the challenges of acute EHR implementations with the potential for many more issues. Delivering an EHR program to scores of ambulatory practices requires enterprise-grade IT scaled down to the practice level at a reasonable cost. The sweep of EHRs includes many aspects of the way healthcare is delivered, affecting processes developed informally over decades. To translate so many manual processes into a tightly defined EHR is a major undertaking.

To deal with the complexity, time, and costs of EHR implementation within a short time period, a solid planning method must be in place. A rapid implementation planning process, called EHR RIP, can focus organizations and guide them in developing a plan that will help bring success.

RIP is a systematic approach that helps organizations establish their EHR objectives, translate them to functional and technical requirements, and identify all resources needed to implement an EHR. RIP also helps to establish realistic budgets, define roles and responsibilities, identify additional resources that need to be hired or contracted, and schedule every element in a detailed timeline.

RIP is a workshop-based process that unfolds in four to six weeks. The working sessions focus on gaining agreement on the strategy, defining functional requirements, and setting the scope of the program. As the plan takes shape, the process delves into the stated and implied assumptions, bringing them to the surface to ensure they will be addressed during the detailed planning.

The process begins with stakeholder executives and the implementation team at a kickoff meeting that establishes overall program objectives at the 40,000-foot level. The first working session descends to 10,000 feet to translate strategic objectives into strategic requirements that will fulfill each high-level goal grouped into program phases. The focus then descends to treetop level in subsequent workshops to map strategic requirements to specific functional requirements for data, access, and security. The rollout’s scope is defined in terms of the number of practices, providers, and users; their locations; and the interfaces they will use. The process drills down to illuminate all required resources and identify their likely costs.

RIP contains several important steps. These include: planning, design, building, and implementation. Each of these steps is successively broken down into activities. The following are examples of activities within each step:

Planning:

— Validation of existing EHR planning against best practices

— Establish project governance

— Develop high-level budget

— Establish project management

Design:

— High-level technology and requirements design

— Clinical standards design

— Budget refinement

— Implementation plan finalization

Building:

— Clinical buildout

— Integration and testing

— Implementation budget finalization

Implementation:

— Pilot rollout

— Pilot assessment

— Refinement

— Implementation and design changes

— Budget review

— Implementation

Basic Concepts of an Information System

An IS is the integration of several elements of a business process to achieve a specific outcome. The system receives and processes input and provides output. For instance, a physician ordering a lab test is a business process. The input is the order for the lab test. The output is a report from the laboratory. An IS is essential in integrating all the elements of the process so that the laboratory test is performed. For the system to work, the physician must provide the laboratory with specific information about what test is to be performed, when it needs to be performed, and on whom it is to be performed. The laboratory must schedule the requested test, collect the sample, analyze the sample (usually with the aid of a computer system), and finally report the test results to the physician. As you can see, the IS integrates all of the steps of the test-ordering process.

A well-designed and well-managed IS is critical for supporting the purposes of the health record. Accurate data can provide physicians, nurses, and administrators with information to make sound decisions. Bad data, on the other hand, can create bad decisions that can affect the health of patients. In Computers, Communications & Information, Hutchinson and Sawyer (2000, 9.2) define an information system “as a collection of related components that interact to perform a task in order to accomplish a goal.” All organizations generate information that must be managed and used in ways that allow them to accomplish their goals. “In addition to coordination among elements, systems must also be adaptive. That is, they must be able to respond to environmental changes by self-correcting the relationships among their internal elements” (Johns 1999, 368). Computers often are used to assist organizations with this challenging task.